Search for tag: "scoliosis"

Dr. Miller: Surgery for spinal scoliosis. We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on the Scope.

Dr. Miller: Hi, I'm Dr. Tom Miller and I'm here with Dr. Darrel Brodke, he's an orthopedic surgeon at the University of Utah. He's also a spine specialist. Darrel, after conservative therapy some patients may not do as well as expected and they end up in your hands again where you may advise surgery. Tell us a little bit about that expectation and what happens.

Dr. Brodke: Patients often with adult scoliosis often caused by degenerative disease, degenerative disc disease, and therefore in a subsequent deformity also have other problems related to that lumbar spine. Specifically low back pain and pain radiating into their legs. They may also have pain with associated numbness and weakness and fatigue. All of that may progress despite non-operative treatment, despite physical therapy, medications, even injections. And it's then that we start to talk about surgical intervention. And surgery often necessitates a big surgery, not a little surgery, and by big surgery I mean surgery that may take many hours and require several days in the hospital and several months of recovery.

Dr. Miller: This is because you're operating on multiple levels of the spine, trying to straighten that curve that shouldn't be there.

Dr. Brodke: Exactly. We're working both on making room for the nerves, decompressing anything that's pressing on the nerves, and then straightening the spine and holding it there with metal instrumentation: screws and rods and spacers.

Dr. Miller: So this is a long surgery, but I imagine the recovery is also long.

Dr. Brodke: Yes. The surgery itself can take many hours. It varies depending on how many levels of the spine are involved and how much we need to do. The recovery, likewise, can vary but usually is on the order of months, not on the order of hours or days.

Dr. Miller: So tell us how you advise, sounds like the rehabilitation after the surgery is a significant part of the treatment. So do you send a patient to just physical therapy or do you send them to a physical therapy physician? Tell us a little bit about that.

Dr. Brodke: Postoperatively we're working with physical therapy immediately after surgery. While still in the hospital, patients are getting up and walking and learning techniques of movement and balance with a physical therapist. Once they leave the hospital, some patients go straight home and can walk as their main therapy and their therapy for the next few months as the bone is healing is walking. Some patients aren't quite ready to go home and will end up in a rehab facility where they work every day with physical therapy until their strength and balance has come around.

Dr. Miller: And that's very intensive

Dr. Brodke: It can be very intensive, several hours a day work in order to get to the point where they're ready to be walking around the home and even outside the home.

Dr. Miller: Now you mentioned you put some hardware in the back and to straighten the spine, I think you use metal rods and hooks and things like that and it sounds kind of daunting and it actually really helps straighten that spine.

Dr. Brodke: Yes, it does sound daunting and it's rather impressive when patients and their families see the X-rays but the screws and rods that we use, mostly made out of titanium today, really help us straighten the spine and hold it there while the spine is healing from the surgery.

Dr. Miller: So the hardware once it's implanted doesn't cause pain. It actually helps prevent it.

Dr. Brodke: Exactly. It helps prevent the pain, it helps hold the position that we want to hold, and it doesn't really hurt long-term either. Most patients don't need their hardware removed. It just goes along for the ride for the rest of however long that ride is.

Dr. Miller: So for our audience, it sounds like a small number of patients would need to have surgery to repair scoliosis. Basically this is a long and complex procedure followed by several months of rehabilitation but at the end of that if everything is going correctly you're going to feel better, you're going to have a better . . . going to have less pain, and you're going to be more functionable with your life.

Announcer: Thescoperadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com.

Dr. Miller: Scoliosis - A Bend in the Spine. We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: Hi, I'm Dr. Tom Miller and I'm here with Dr. Darrel Brodke. He's an orthopedic surgeon and a spine specialist here at the University of Utah. Darrel, what is scoliosis exactly?

Dr. Brodke: Scoliosis is a curve in the spine. Technically it's a curve that goes sideways in the spine, because our spine naturally curves in the forward-backward plane, but sideways it's supposed to be straight.

Dr. Miller: How do we get scoliosis, which sounds kind of abnormal?

Dr. Brodke: Yeah, there are a number of ways to get scoliosis. The most common, frankly, is arthritis in the spine as an older adult. That is a very common way to get scoliosis as an adult. But what we commonly think of when we think of scoliosis is teenaged kids with a curvature in the spine that was picked up by the school nurse. That's called, the most common version of that, adolescent idiopathic scoliosis, and it's also fairly common but not quite as common as the degenerative kind in the elderly.

Dr. Miller: So we hear that a lot of people have scoliosis. Do the majority of those people not have problems, they just live with the scoliosis?

Dr. Brodke: Absolutely. In fact, most kids and adults with scoliosis often find out they have scoliosis because they're being evaluated for a different problem and never really had known that they had scoliosis before that evaluation and it doesn't really affect them in any way.

Dr. Miller: It doesn't change their lifestyle, doesn't impact their livelihood.

Dr. Brodke: Exactly.

Dr. Miller: And it doesn't progress?

Dr. Brodke: It doesn't progress in most people.

Dr. Miller: Now the other type of scoliosis you mentioned is due to arthritis, so as patients are getting older that sounds a little more concerning.

Dr. Brodke: It can be. It can also be fairly benign. It can be an incidental finding when somebody is being evaluated for low back pain, for a muscle strain, for example, and it might have nothing to do with the low back pain. Alternatively, it may be very involved in the patient's problem in their low back, for example, when there's involvement of nerve compression, and we often see that in degenerative scoliosis.

Dr. Miller: Now patients that have scoliosis who don't have any problems, I suppose they would not need to see anyone. When would a person with scoliosis need to see a spine surgeon such as yourself? Would it be because of pain or limited mobility?

Dr. Brodke: There are probably two main reasons and then a third that's common. I'll start with that third. The common reason is because they're concerned about it. They don't know very much about it and they want to talk to somebody who treats this regularly and would like to get more information. That's a very common reason to see a physician, and that's a completely valid reason. Most of those appointments are about patient education and reassurance and they don't lead to surgical intervention.

There are times when the scoliosis can be a problem and should be seen by a specialist that sees and treats and operates on scoliosis. Probably the most common in adults, the adult scoliosis form, is when the patient feels very out of balance, either forward or sideways in a way that they can't straighten up, or they feel like their pain radiates down their legs and/or they have numbness and weakness in their legs and they can't do the things that they would like to do.

Dr. Miller: So treatments would include graded therapy. So you'd start conservatively or do you need to go to operative therapy?

Dr. Brodke: We will almost always start conservatively with physical therapy and medications like ibuprofen or naproxen, anti-inflammatory medicines, and sometimes we'll escalate to an epidural steroid injection or a little bit more aggressive treatment of pain. And if all of those fail we may talk about surgery.

Dr. Miller: So the small percentage of patients with scoliosis would go on to surgery?

Dr. Brodke: That's correct.

Dr. Miller: So to wrap that up for our audience, basically scoliosis is a fairly common condition especially in the younger patients or in younger people, and usually is not progressive, does not cause symptoms, and you live with it without any trouble whatsoever. But in some people it is problematic. It can impair function, it can cause pain, and for that reason you would see a spine specialist and they would prescribe variable therapy from conservative therapy, including physical therapy and non-opioid analgesics such as ibuprofen and Naprosyn, and then a few would need surgery ultimately.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: June 25, 2019
originally published: June 14, 2016

Dr. Gellner: Most of us have heard our mother's say, "Stand up straight you're going to make your back so it's hunched over." Well what if the back problem has nothing to do with your posture and has more to do with your spine? We're going to talk about scoliosis today. I'm Dr. Cindy Gellner on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Gellner: So most of you if you've been to seventh grade you've had the spine check where they have you take off your shirt, bend over, touch your toes, and they look at your back. Most of us start checking the spines around age 10 or 11, because that's usually when kids are about to have their big growth spurt, and during the growth spurt that's when you're usually going to pick up scoliosis.

So scoliosis is basically meaning that the spine curves from side to side rather than going straight down the back and it most often effects the bones in the upper back not the lower back. So if your child has lower back pain we need to think of another issue going on. Most likely that's going to be a muscle problem not a spine problem.

Scoliosis happens more in girls than boys. Scoliosis does seem to run in families and the cause really isn't that known, it could be caused because the bones in the spine aren't shaped correctly, the legs are different lengths, the rib muscles pull harder on one part of the spine than the other causing the bones to twist and move out of line. If you've had an injury to your spine it can cause some curving, some certain diseases like cerebral palsy also make people more prone to scoliosis.

How do you know if you have scoliosis if you haven't been to a doctor and no one's checked your back? Well there are other things to look for. If your shoulders are uneven or your hips are uneven, like one is higher than the other, if you are bending over and somebody says, "Wow what's that hump on your back on the left side?" That could be a sign that your spine is crooked. If one or both of your shoulder blades are sticking out, not just because you're skinny, but they are actually like sticking out like wings, if you have a slight lean to one side but it's only from the waist up, or if you're having a lot of mid to upper back pain.

So if we do pick up scoliosis on the physical exam, what do we do about it? Well the first thing we're going to do is an X-ray. If your child's x-ray shows that the scoliosis is less than 10 degrees, we just monitor it. When we do the x-ray we can actually measure the angle of the curve using something that looks like a protractor like you used in math, and if it's more than 10 degrees but less than 15 we usually just monitor it once a year. If it's between 15 and 20 degrees we monitor it every six months. If it's more than 20 degrees that's when we get the bone doctors involved, the orthopedic doctors, because if it's that bad then we need to have the orthopedic doctors talk to you about the treatment options.

Sometimes people if their spine is that crooked they need to wear a back brace. Sometimes physical therapy can help. It also helps your child learn proper posture and helps keep your child with a good range of motion so they can move in all directions, and quite often by helping to strengthen the muscles around the spine. It also helps with the pain and muscle spasms that some people get with scoliosis.

If the scoliosis curve is severe then you're child may need to have surgery but that's not very common unless you have one of those other predispositions for having scoliosis like cerebral palsy.

So how can you help with scoliosis? Well unfortunately there's not a whole lot you can do. This is something, again with just how they're spine grows and genetics, because again it does tend to run in families. But that old adage of, "Stand up straight," yeah it's a good thing to do. Your child needs to remember to stand up straight, practice good posture that will help with all the back muscles too.

Your child also needs to learn how to protect their back, so that means if they're going to lift something heavy they need to bend at the knees not with their back. If they're carrying heavy backpacks, which going back to school that's something that a lot of people are going to be dealing with, they need to remember to use both straps on the backpack. Your backpack comes with two straps for a reason so you need to actually use both of those rather than just having on one shoulder, because that will also cause strain on the back. Also kids who are overweight can lose some weight and that also helps back muscles. A lot of back pain is due to extra weight.

If your child does have scoliosis, especially if they need some of the interventions like needing to wear a brace, that can be something they're very self-conscious about so make sure that you talk to your child and let them know, "Hey this isn't anything you did or you have any control over and it's a short term fix so that you can fix a long term problem."

So if your child can't stand up straight or you notice any of those other signs, have your pediatrician check out your child's back and make sure that they don't have the early signs of scoliosis and if they do you can get it fixed.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.